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Background: Stroke is the second leading cause of death both in Iran and worldwide. However, few studies have monitored performance measures within stroke systems of care, revealing low rates of stroke code activation and intravenous recombinant tissue plasminogen activator administration. To explore experiences, barriers, and effective interventions for improving stroke code management this study was conducted. Methods: This study will use a three-phase, exploratory sequential mixed-methods design and followed SPIRIT guideline for reporting protocol study. In first step, data will be collected through interviews with patients or caregivers and stroke code team members. The development phase will involve consultation with a panel of experts. Finally, based on the data from the qualitative and development phases, an optimized intervention will be implemented and evaluated. Participants will be recruited via purposive sampling with maximum variation. The study is scheduled to commence in March 2024 and conclude in December 2024. Results: In the first step, we will deeply explore the rich data about the problem, and challenges. In the second step, we will find the solution and design the intervention based on the data from the first step. Finally, in the third step, we will implement and evaluate the intervention. Conclusion: This approach aligns with current evidence and best practices by integrating qualitative and quantitative methods to inform the development, execution, and evaluation of a tailored intervention. The findings are anticipated to strengthen Iran’s national stroke code program and offer valuable insights into the facilitators and barriers affecting stroke management.

Objectives This study aimed to examine serum miRNA-124 expression in patients diagnosed with hemorrhagic cerebrovascular accident (CVA) and evaluate its clinical significance. Methods A prospective observational study was conducted involving 20 patients diagnosed with hemorrhagic CVA who were admitted to the Department of Neurosurgery, Affiliated Hospital of Beihua University. Quantitative reverse transcription polymerase chain reaction was used to measure serum miRNA-124 levels within 12 h of symptom onset and on day 7 after onset. Results Paired t test analysis yielded a test statistic of t  = 3.499 ( p  = 0.002), indicating a statistically significant difference between the two timepoints. Serum miRNA-124 levels on day 7 were significantly higher than within 12 h of onset, possibly reflecting the progression of post-hemorrhagic cerebral edema. Conclusions Serum miRNA-124 expression in patients diagnosed with hemorrhagic CVA was significantly higher on day 7 after onset than within 12 h. This finding aligns with previous reports suggesting a potential relationship between miRNA-124 upregulation and the development of cerebral edema after hemorrhagic CVA.

Large databases provide an efficient way to analyze patient data. A challenge with these databases is the inconsistency of ICD codes and a potential for inaccurate ascertainment of cases. The purpose of this study was to develop and validate a reliable protocol to identify cases of acute ischemic stroke (AIS) from a large national database. Using the national Veterans Affairs electronic health-record system, Center for Medicare and Medicaid Services, and National Death Index data, we developed an algorithm to identify cases of AIS. Using a combination of inpatient and outpatient ICD9 codes, we selected cases of AIS and controls from 1992 to 2014. Diagnoses determined after medical-chart review were considered the gold standard. We used a machine-learning algorithm and a neural network approach to identify AIS from ICD9 codes and electronic health-record information and compared it with a previous rule-based stroke-classification algorithm. We reviewed administrative hospital data, ICD9 codes, and medical records of 268 patients in detail. Compared with the gold standard, this AIS algorithm had a sensitivity of 91%, specificity of 95%, and positive predictive value of 88%. A total of 80,508 highly likely cases of AIS were identified using the algorithm in the Veterans Affairs national cardiovascular disease-risk cohort (n=2,114,458). Our algorithm had high specificity for identifying AIS in a nationwide electronic health-record system. This approach may be utilized in other electronic health databases to accurately identify patients with AIS.

This book provides a comprehensive clinical review of the diagnosis and treatment of patients with ischemic cerebrovascular disease. The book includes chapters on the clinical features of transient ischemic attacks and ischemic stroke, risk factors, and evaluations. Additional chapters discuss causes of stroke including atherosclerosis, cardioembolism, non-atherosclerotic vasculopathies, and pro-thrombotic disorders. The causes of stroke in children and young adults are highlighted. The final section of the book includes chapters on therapies to prevent stroke, acute stroke treatment, general management of the patient with recurrent stroke, and rehabilitation. The volume is heavily referenced with an emphasis on recent publications so that the reader can pursue additional information about a topic. It also includes several tables and algorithms that should aid the clinician treating patients with cerebrovascular disease.

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Bill & Melinda Gates Foundation.

This book explores the journey from the traditional belief that visual field loss due to brain injuries is irreversible to recent research suggesting that repetitive stimulation can partially restore vision, aiming to bring light back to patients' darkened world.

Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June–July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51–325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.

Written by the world's foremost authorities, this volume reviews the latest basic science and clinical advances in the prevention, diagnosis, and treatment of ischemic stroke. The contributors examine recent breakthroughs in laboratory and clinical research and relate these research findings to clinical practice. Major sections focus on the epidemiology of ischemic stroke, the arterial lesions of stroke, the consequences of ischemia, risk factors for stroke, and strategies for prevention and treatment. Coverage includes detailed information on the new neuroprotective agents that have recently been developed and the new diagnostic procedures used to determine the best way to protect the brain during stroke.

Ultrasound is a vital observational tool. Intended for clinicians who are eager to learn and prepared to observe, this book focusses on the examination of stroke patients, the interpretation of ultrasound studies, and the application of cerebrovascular ultrasound to management and treatment strategies